Provider Demographics
NPI:1063478881
Name:CONNELLY, LYNNE (NNP)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 E PRESIDENT GEORGE BUSH HWY
Mailing Address - Street 2:SUTIE 250
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3542
Mailing Address - Country:US
Mailing Address - Phone:214-343-6663
Mailing Address - Fax:214-343-2814
Practice Address - Street 1:3001 E PRESIDENT GEORGE BUSH HWY
Practice Address - Street 2:SUTIE 250
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3542
Practice Address - Country:US
Practice Address - Phone:214-343-6663
Practice Address - Fax:214-343-2814
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX642405363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX642405OtherLICENSE